Healthcare Provider Details

I. General information

NPI: 1477182095
Provider Name (Legal Business Name): LARA DANIELLE SLESNICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

820 S WOOD ST RM 287
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6000
  • Fax:
Mailing address:
  • Phone: 312-996-0532
  • Fax: 312-996-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME174815
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: